Surgical treatment of persistent vaginal granulation tissue using CO₂ laser vaporization under colposcopic and laparoscopic guidance

Introduction: There have been many reports in the literature on vaginal mesh erosion as a complication of pelvic floor reconstructive surgery. Several reports describe successful surgical excision of the exposed mesh as a resolution. However, in rare cases of mesh erosion, poor surgical outcomes and multiple resection failures have been reported. We describe an innovative surgical approach to persistent vaginal mesh erosion using CO₂ laser vaporization under colposcopic and laparoscopic guidance. Case Description: A 58-y-old postmenopausal woman first presented with a 3-y history of vaginal discharge and spotting after undergoing a Mentor ObTape transobturator sling (Mentor Corp, Santa Barbara, CA), for the treatment of stress urinary incontinence. Despite surgical removal of the mesh and multiple attempts at cauterization of persistent granulation tissue, her symptoms persisted. Discussion: Using a CO₂ laser under colposcopic and laparoscopic guidance, we were able to safely expose and remove the remaining portion of retained mesh. To our knowledge, this is the first report describing CO₂ laser vaporization as a surgical approach for the successful treatment of recurrent mesh erosion.